Comprehensive Care Practice for the Entire Family

Special Cases

Case #1 Patient presented with a chief concern of cold and hot sensitivity in her teeth. She had no apparent headaches but was only chewing on her right side. Clinical evaluation revealed multiple teeth with fractures, old mercury fillings (black), and broken white fillings. Palpation of all the Muscles of Mastication (chewing muscles) revealed more tension and tenderness on the right side. When she opened her mouth, the jaw moved towards the right side where the tension was focused. Ultrasound of the Temporomandibular Joint revealed Crepitus (gravel) noise bilaterally. Review of the function of the teeth revealed significant interferences when moving the jaw left, right, and forward contributing to the fracture of the back teeth. Multiple front teeth had mobility. Treatment involved an Orthotic Appliance to relax the muscle and then an adjustment to the teeth to re-balance the bite. The muscle tension and aberrant jaw movement disappeared and the tooth sensitivity stopped. The restorative care pictured is primarily focused on the back teeth and are all Porcelain- Esthetic Crowns.

 

 

 

 

Case #2 Patient presented with the chief concern that she was not happy with the esthetics of her front tooth. Patient had an history of traumatized front tooth as a child. Root Canal Therapy and many restorative treatments had also affected the tooth therefore, the tooth's Long-term prognosis was very poor. Replacing a single front tooth, specially one with an implant, is perhaps the most challenging procedure. A single implant was placed in the position of the tooth that was extracted. It is important to mention that at no time was the patient left without a replacement tooth.

 

 

 

 

Case #3 Patient presented with a chief concern of wanting his teeth to look better. Orthodontics as a child involved the extraction of 4 teeth. Clinical evaluation revealed Crepitus in both Temporomandibular Joints with tenderness in the Right Joint on Palpation. The patient revealed that he had episodic periods of pain. Motion studies revealed limited range of motion to the right side. The treatment involved utilizing an Orthotic Appliance to relax the muscles and establish a stable position for the jaw joint. The range of motion returned to normal with no palpable pain in the Temporomandibular Joint. The transitional crowns were pre-fabricated to match the new jaw position. The crowns stability and comfort in the new position were monitored for a few months before the final crowns were fabricated. The front teeth were all restored in All Porcelain Crowns for optimum esthetics.

 

 

 

 

Case #4 Patient presented with the chief concern that every time she goes to her dentist there is always another crown to do and there was not any discussion about the cause of her teeth breaking. Her fear was that she would eventually be in a denture at the rate teeth were breaking. Clinical evaluation revealed that multiple chewing muscles were tender to palpation. On opening, the jaw deviated significantly to the right and had limited range of movement to the left. The imbalances in the muscles corresponded to the change in the function of the jaw, as indicated. The treatment constituted utilizing an Orthotic Appliance to relax the muscles and to verify a stable Joint position. The placement of single implants in the right posterior region and three implants in the upper left region allowed for a stable bite bilaterally. The Anterior restorations were fabricated to improve the jaw function that was discovered in the Appliance Therapy and verified in the Transitional Crown phase of therapy. It has been four years since the completion of the patient’s therapy and her last statement was that she no longer worry about her teeth.